Pain isn’t simply unpleasant. It can be life-threatening, says associate professor Gayle Page, DSNc, RN, FAAN, director of the PhD program. “My whole goal in life is to get people to think about pain and to medicate in anticipation of inflicting pain,” she says.
In the case of postoperative pain, the immediate repercussions can be critical. Through a research study published in the 2002 Journal of Pain with co-investigator Shamgar Ben-Eliyahu of the Tel Aviv University, Page demonstrated how resulting pain from cancer surgery can suppress the immune system’s natural killer (NK) cells, triggering an inflammatory response that greatly increases the chance of subsequent tumor development.
In the study, anesthetized rats were subjected to surgery and injected with cancer cells. To counter the effects of postoperative pain and inflammation, Page gave a common nonsteroidal anti-inflammatory drug (NSAID), Indomethacin, to a control group of the rats. The NSAID reduced tumor promotion in that group by more than 50 percent. “If our results in animals prove to be similar in humans,” she said, “controlling postoperative pain and inflammation must become a priority in the management of cancer patients undergoing surgery.”
The results of Page’s research have since taken on added dimensions. Acknowledging that the use of certain NSAIDs like Indomethacin (classed as COX-1) can cause stomach bleeding and other problems, Page has broadened her surgery study. In recently completed research, she employed a new generation of NSAIDs known as COX-2 inhibitors that can repress the body’s inflammatory response to pain without harmful side effects. “What we did was to replicate our study again with a selected COX-2 pro-drug, tested directly against a group that received Indomethacin,” she says. “Basically the results are the same in both groups of test animals.” Page expects the results of this new research to be published in 2005.
Most recently, Page has moved back to her primary professional interest in pediatrics, the field in which she started as a nurse. She is presently investigating the implications of perinatal pain, physical trauma to a baby that occurs just before, during, and immediately after birth due to early delivery or other complications. Through a current study, supported by a grant from the National Institute for Nursing Research at the National Institutes of Health (NIH), Page is looking to demonstrate a clear link between postnatal pain experiences and neuroendocrine and immune responses to stress in mature animals. “My research is showing that this may be the case scientifically,” she says, “which is all the more unfortunate when applied to human newborns. These kids who go through neonatal intensive care units are just unmercifully poked and prodded. There’s got to be some kind of consequence to that.”
— Dave Beaudouin
For the past three years, hundreds of elementary school-age children on Maryland’s Eastern Shore have been learning a new lesson—how to manage their asthma successfully. This “educational intervention,” which also involves parents and school nurses, is part of a sweeping, four-year study that seeks to gauge how the introduction of educational programming can improve the quality of life for rural children with asthma, and for their families. According to the study’s principal co-investigator, associate professor Marilyn Winkelstein, PhD, MS, MSN, the “A+ Asthma Rural Partnership” has far-reaching implications in the field of community-based health care. “Asthma is the most common chronic disease to affect children aged 5 to 14 and is responsible for most of their absences from school,” she notes. “So it really does interfere with their quality of life—and that of their parents as well, who must miss work to stay home to care for their children.”
Launched in 2001 through funding from the National Institute of Nursing Research at NIH, the study is seeking to enroll nearly 300 children from grades 1 through 5 in seven rural Maryland counties, along with corresponding parents and school health staff. Counties have been divided up into two groups, with one receiving the full school-based educational intervention and the other serving as a standard control group. The educational intervention, which is voluntary and is coordinated through local school health staff, consists of a series of classes and study materials targeted specifically for children of various ages, as well as comprehensive workshops for their parents and school health nurses.
“We’re teaching families about asthma and how to manage it effectively,” says Winkelstein. The study will complete its final field research this spring, with a goal of completing its findings by March 2005. Says Winkelstein, who has a joint appointment at Hopkins’ Children’s Center, “After the study is done, we want to leave the knowledge and the resources from our educational efforts with these communities.”
When prenatal care includes substance abuse treatment, the treatment’s success is crucial to achieving a healthy birth outcome. But what determines whether or not a woman stays in substance abuse treatment?
Funded by the school’s Center for Health Disparities Research, Benita Walton-Moss is investigating how self-perception of physical and mental health status figures into treatment adherence by low-income women in urban environments, where substance abuse is particularly evident. A better understanding of women’s perceptions of their health may lead to better drug treatment programming, says Walton-Moss, DNSc, RNCS,FNP. For instance, finding a correlation between women who perceive their health as being better and longer length of time in drug treatment might warrant an intervention with more emphasis on health, such as proper eating and exercise. By improving treatment approaches, Walton-Moss aims to increase the likelihood that women successfully complete substance abuse treatment and to subsequently improve birth outcomes.
A recipient of a Johns Hopkins Provost Undergraduate Research Award, senior Megan O’Brien Gold, set out last fall to investigate the prevalence of gonorrhea and chlamydia among battered women and their willingness to be screened with a urine test, a fast, inexpensive, and accurate method for screening. Her project involved women seen at the School of Nursing’s Wald Community Nursing Center located at the House of Ruth, a local shelter for female victims of domestic violence.
The center currently offers STD screening through cervical swab as part of its nursing services, but only to those women who request it. Gold began her project knowing that research has linked abusive relationships with increased rates of STDs among women, that gonorrhea and chlamydia are the most frequently reported infectious diseases, and that women with undiagnosed and untreated infections are at risk for serious gynecologic problems and increased risk of HIV transmission. Her findings—one out of 21 women tested positive for chlamydia and all women were willing to participate and favorable to the urine testing method of screening—may lend support for the implementation of universal urine screening for gonorrhea and chlamydia in the future.